In nursing, one of the only things that stays the same is change, and the coming decade is already promising a number of shifts.

Betty Adams, RN, PhD and dean of Prairie View A&M University's College of Nursing, said the aging population, the growing and diverse population of the state, and the Affordable Care Act of 2010 are energizing many of the current and future changes in health care.

"Because the responsibilities of nurses are growing more complex, the necessity for more education led us to develop our first Doctor in Nursing Practice program," Adams said. "This new degree will be initiated in January 2014 and we plan to accept a class of 12 at minimum."

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Nursing by the numbers

Projected growth 2008-2018 - 581,500 jobs

Registered nurses in U.S. - 3.1 million

RNs employed in the U.S. - 2.6 million

Nurses with BSN degrees or higher - 50 percent

Nurses with master's or doctorate - 13.2 percent

Projected nursing shortage by 2025 - 260,000

Source: American Nurses Association, 2010

Adams said the new program, supported by the Houston Endowment, will focus on evidence-based nursing practice and will be the capstone to the primary care role in nursing, creating strong leadership and incorporating the latest research into best practices.

"We are planning to announce application deadlines for our first DNP class before year's end," she said.

Prairie View's College of Nursing has become a greatly diversified training ground for students of all ethnicities, races and cultures.

"We are particularly proud of this diversity," Adams said, "because our nursing students become familiar with their multicultural fellow students during training, an environment that mirrors the patient populations they will serve in the future as nurses."

"The Future of Nursing," a report published in 2011 by the Institute of Medicine, the Robert Wood Johnson Foundation and the AARP, cited the Affordable Care Act as "representing the broadest health care overhaul since the 1965 creation of the Medicare and Medicaid programs."

The report went on to say the act is "transforming the health care system to provide safe, quality, patient-centered, accessible, and affordable care," a move requiring "a comprehensive rethinking of the roles of many health care professionals, nurses chief among them."

Adams said the transformation envisioned in this report mandates expansion of nursing education, both before and after nurses receive their licenses.

"We are working to advance the system by helping nurses achieve higher levels of training and education because of more patients, chronic conditions and a changing society," she said. "Before, our challenges in health care came with treating acute illnesses and injuries. Today, health care providers see more patients with chronic conditions. Our system must change to accommodate these needs."

Ellerene Sanders, RN, PhD and interim executive director of the Texas Nurses Association, said along with changing needs, the nursing profession also must respond to the increasing demand for nurses as well as the additional opportunities emerging in the profession.

"Sixty-three percent of Texas nurses are employed in hospitals," she said, "but the percentage of nurses employed in other environments is increasing. New roles are accompanying the need for care coordination, changes in insurance coverages and the growing mandate for more highly educated nurses."

The Texas Team, an action team focusing on the future outlook on nursing, is working to increase the number of RNs trained in the state, and the opportunities for RNs to earn their bachelor of science in nursing degrees.

"We recently ran some numbers," Sanders said, "and we're currently producing 5,000 BSN nurses. Because of the growing population and the increasingly aging population, we need to be producing 17,000 to meet the needs in health care by 2020," she said. "We're also seeing a growing and significant role for advanced practice registered nurses in extending primary care services.

"One of the newest trends in nursing education has been the increasing cooperation between various types of nursing programs," Sanders said. "Educators around the state have become one body, realizing the continuing need all the nurses all of these programs produce, and they are working together to help nurses move seamlessly from RN to BSN in Texas.

"Texas Nurses Foundation is working with a grant from the Robert Woods Johnson Foundation with the goal of producing more RNs in Texas, making it easier for students to advance from the RN to BSN and then diversifying the nursing student population to better reflect the Texas patient population. Tools provided from the grant include tutors and mentors from the same ethnicities, races and cultures as the students.

"If we are to increase the numbers of nurses with BSNs, we will need more faculty and in Texas, nurses who go on in their educations to earn their doctorate so they can teach and take on other roles in education."